Predictive Value of Computed Tomography With Coronal Reconstruction in the Right Hemicolectomy With Complete Mesocolic Excision:A Retrospective Study.

Abstract Background:Understanding vascular anatomy is critical for performing central vascular ligation (CVL) in the right hemicolectomy with complete mesocolic excision (CME). This study was aimed to investigate the predictive value of multi-slice spiral computed tomography (MSCT) with coronal reconstruction in the right hemicolectomy. Methods:Eighty patients who underwent right hemicolectomy in our hospital were included. The intraoperative imaging data and the images of MSCT with coronal reconstruction were analyzed retrospectively. The detection rate of the ileocolic vein (ICV) and ileocolic artery (ICA) location and the accuracy of the preoperative prediction of their anatomical relationship were analyzed. The detection rate and preoperative prediction accuracy of the gastrocolic trunk of Henle (GTH), middle colic artery (MCA), and middle colin vein (MCV) were analyzed. The distance from the ICV root to the GTH root (ICV-GTH distance) was measured and analyzed. The maximum distance from the left edge of the superior mesenteric artery (SMA) to the right edge of the superior mesenteric vein (SMV), named “leSMA-reSMV distance,” was measured and analyzed too.Results:74 (92.5%) patients had been located both the ICV and ICA roots and determined the anatomical relationship between them by MSCT, of which 72 were confirmed by intraoperative findings，and the accuracy was 90% (72/80). GTH was located by MSCT in 75 (93.7%) patients, and the accuracy was 91.25% (73/80). MCA was located by MSCT in 47(58.75%) patients, and the accuracy was 46.25% (37/80). MCV was located by MSCT in 51 (63.75%)patients, and the accuracy was 53.75% (43/80). The ICV-GTH distance was measured in 73 (91.2%) patients, and the mean distance was 4.28±2.5cm. The leSMA-reSMV distance was measured in 76 (95%) patients, and the mean distance was 2.21±0.6cm. Conclusions:MSCT with coronary reconstruction can locate the roots of ICV, ICA, and GTH, predict the boundary of SMA and SMV, analyze the anatomical relationship between them, and estimate the location and range of central ligation region, which are of some predictive value in central vascular ligation in the right hemicolectomy with CME.